VAntage Point

Update: Office of Rural Health

With 41 percent of enrolled Veterans living in rural areas, the need for improved access to quality health care for rural Veterans has led the VA to transform the way health care is delivered. Rural Veterans face challenges when trying to access to quality health care because of the shortage of health care resources in rural areas, as well as the lack of specialty care providers. The Office of Rural Health (ORH) is working to ensure that rural Veterans have access to the health care they deserve.

VA is working to shift the current health care system from “problem-based disease care” to one that is “patient-centered and healing”. This change is being accomplished by adapting the VA health care system to the changing demographics and needs of our Veterans in rural areas. For example, there is an increasing demand for women’s services for Veterans in rural areas. The number of women Veterans seeking VA health services has doubled, from 150,000 in 2000 to 300,000 in 2010. This demand is being met by increasing specific women focused services such as maternity and menopausal care services and by providing training in women Veterans health care services to rural providers. In addition, most rural Veterans are in the 55 to 74 age group, therefore they need care focused on management of chronic conditions such as hypertension, diabetes and heart disease.

Technology has become an important tool used to increase access to health care. Almost one-third of the entire ORH project portfolio in FY 11 consisted of expanding telehealth capability to rural areas and creating new models of care using telehealth technology. One such project expands access to care nationally for Veterans living in rural areas through the use of care-coordination home technologies (CCHT). This program focuses on patient self-management of chronic conditions such as diabetes via a range of telehealth technologies that include messaging, monitoring, and video devices. Other ORH projects funded in FY11 fall in one of the following areas: Primary/Specialty care, new rural CBOCs, and rural expansion of Home Based Primary Care.

VA is focused on transforming from an inpatient hospital system into a continuum of care health system by expanding home-based primary care, community- based outpatient clinics, telehealth services and online health programs into rural areas. In addition, ORH has initiated a national expansion of outreach services for homeless Veterans living in rural and highly rural areas, by partnering with the VA Office of Mental Health.

Using VA data sources, ORH can report the following progress:

The number of rural health outpatient mental health visits increased from 3.4 million in FY09 to 3.9 million in FY10

The number of rural women veterans impacted by ORH projects: 8,636 by the end of FY10

From FY10 to FY11, the number of new mental health appointments at ORH funded new community-based outpatient clinics increased from 111 to 587.

From FY10 to FY11Q1, approximately 416,132 rural veterans were impacted by ORH projects.

From FY10 to FY11Q1, approximately 57,191 unique patients were seen at ORH-funded rural CBOCs

ORH continues to fulfill the VA mission by funding and overseeing sustainable projects that will improve the lives of ruralVeterans. Future progress will be reported here as we continue to support projects, programs and initiatives that help rural Veterans lead healthy lives.

Mary Beth Skupien, PhD, MS, RN, is the Director of the Office of Rural Health for the U.S. Department of Veterans Affairs.

Comments

This article cites a figure of 41% of US veterans living in rural areas. The US Census Bureau (http://goo.gl/ndt7z) cites a figure of 21% of the total population (16% living in TRULY rural areas, i.e., not in a community of any sort regardless of size) living in rural areas (see definitions in the chart at the link above).

I live in TRULY rural south Georgia and the nearest VA facility to me, of any type, is the Carl Vinson VAMC (CVVAMC) in Dublin, Georgia. At over 60 miles away, it’s not exactly a community-oriented resource for me. From my house to the CVVAMC it’s a fairly straight drive up one US highway, make a left turn, and then another into the facility. Sounds easy, right? Sure. It would be, if it weren’t 60+ miles away. Also, for those of us who live in these rural areas, DAV or other sponsored transportation vans aren’t always accessible. There isn’t one that services my area, for example.

The point I’m making is that the percentage of US veterans who live in rural areas…we live in rural areas since that’s where so many military recruits come from…is 2-2.5 times higher than the US average. Having neighborhood or community VA clinics is fine, if they’re accessible, but what about those people who have no way to get to one? Is that an issue that’s being addressed by the same 2-2.5 ratio?

Come on, we already know the answer to that: NO! And at this point in our economy, it never will be addressed. Given that the VA is also doing phone checkups with veterans’ Primary Care Providers instead of face-to-face checkups, requiring now that veterans be reimbursed by check up to a month after a scheduled visit for travel pay, I wonder what the next step is. This latter issue makes it hard to impossible for a low-income veteran who doesn’t drive…and that’s a not-insubstantial number…to afford to pay someone to drive him/her to his/her scheduled visits since he/she can’t, in many cases, afford to buy $3.50/gallon gas for the trip in order to reimburse the driver. Add to that that there’s usually a meal away from home involved for not just the veteran but also for the driver and it puts a hardship on those veterans to figure out where to cut money in his/her already strained fixed-income budget until the VA cuts him/her a travel reimbursement check. Not that Washington politicians, who sit on their fat butts while others secure the nation’s defenses, care about veterans. They pay lip service and are quick to parade a veteran or two at campaign time, but as soon as the votes are counted, we veterans are out of their spotlights, and minds.

Also, riddle me this: Why is it that the same politicians who are so quick to pull the trigger on war are the same ones who are also so quick to wield the budget knife on veterans’ medical care? Before someone jumps on THAT and makes it the issue here, let me be the first to say that I agree with the notion that there’s only one political party: The Incumbent Party.

Jim,
I’m not understanding your point. I feel as though the VA could do more for rural vets, but I don’t think you have an issue with this. It sounds like you just need an advance on travel pay in order to get to your healthcare. I haven’t heard of vets having to wait a month for reimbursement. You should be reimbursed on the spot at the VAMC. If that’s the policy of your VAMC, then try to plan ahead. For a 120 mile roundtrip, you probably spend about $30 max in gas. If you can’t budget for this, than you need financial planning help. Seriously. And a meal out? Pack a lunch. I’m not trying to criticize, but your complaints seem to be bogus. I’m sure if the VA put a hospital at your front door you would have a reason to complain. Let’s see some constructive criticism.

Being a vet in a rural area can truly be frustrating. It is 150 miles from our front door to the nearest VAMC. It is very difficult to schedule appointments as you are often disconnected after waiting in the phone queue for an hour or more, which is very discouraging for my blind veteran. We have now been trying to schedule a return appointment that should have been automatically scheduled for over a month. My husband has even reached out twice to his blind rehab trainers to help with the appointment process, yet they ignore them as well, resulting in a 2 month wait for an appointment to be scheduled that was he should have had in April due to the treatment being done. The DAV van scheduling is done by a company outside the area. We quit trying to use it after they gave us the wrong time and location one too many times – somehow scheduling him on a van over 100 miles from where we are heading to the wrong VAMC just does not work well.

Jon-
You really don’t know what you’re talking about. My “local” CBOC is over an hour away. You CANNOT get your travel pay while you are there. It is mailed to you 8-12 weeks later. And the ONLY services available at that CBOC are primary care, psych, social work, and limited lab draws. Everything else requires a trip to the VAMC 2-1/2 hours away. Even an annual Pap smear. I can get travel reimbursement at the VAMC IF my appointment is finished before the travel office closes.

I live in a rural area, and use our Brooksville Clinic. It takes over 2 months to a NORMAL appt. Heck, with PTSD, I might just give up and get lost! And the medical side, is just as bad. Also, smelly,dirty, and bugs everywhere! Felmale veterans are not felt welcome, the groups for PTSD are treated as a ” whenever Tampa Main Hospital” can allow time to meet. They set up the dates, and felmales, are left to chance. THERE IS NO OPEN DOOR POLICY! Who is helping WHO in Brooksville,Fl. ? Slipping away, vet.

I know exactly “where Jim is coming from”! Though I live in Indiana, I have the same problems he does with the VA! I Have to travel 60 miles one way to the closest VA clinic, am on a limited income, live in a very rural area. Not to mention the VA travel section doesnt always pay the travel pay and I have waited upto 3 months to get a travel check (when they send them out). Also the local VFW will not provide transport for me because I live in a very isolated area! At times I ahve had to call and cancel appointments, because of lack of transportation and no way to pay someone to take me to my scheduled appointment!
Larry

Hey Larry, I agree. I live about 95 miles away from a VA Clinic in El Paso, Texas, the closest VA Hospitals to me are either San Antonio, or Albuquerque. The County that I live in Hudspeth County, Texas, is the most sparcely populated, poorest county in the State of Texas. Because of this, 90 percent of my trip into the El Paso Clinic for an appointment is done through “dark country” where there is NO cell phon coverage at all.
There have been several times in the last year that I have had a morning appointment that in order to arrive on time for, I have to start on the trip down the “Texas two lane” Two Hours before anyone is at the clinic, only to find out that the person that I came to see, wasn’t there! Because of that, NO TRAVEL PAY, and I have an old clunker truck, all that I can afford, that only gets 10 miles to the gallon.
I WILL hand it to the Nurses at the VA Clinic though, the last three times that it happened, They arrainged a meetingwith oneof the VA Psychologists that day, so that I could have the money for the gas home, or there would have been a news story of the Vet who was arrested for sleeping in their truck forthe week before payday because they didn’t have the gas to go home.
The VA was going to put it in my records that I should NOT be given an appointment before 10 AM, so that I could CALL FIRST to see if the person was sick or something, but 20 percent of my appointments are still first thing in the morning, and two or three days before I get my Disability check. Brie

There is a pretty cool program operating out of a VA in Asheville, NC that brought a flu shot to my town, and set up another clinic providing a pneumonia shot; now I’m hearing they may be setting up clinics in existing sites by sharing agreements with other federal, state and local health care entities to provide limited appointments for people who otherwise might fall through the cracks…especially in mental health. Talked with a really nice gentleman from the Rural Health program at Grandfather Mountain at the highland Games this past Friday, and the team themselves are excited . I just hope the Feds don’t get in the way and block all of their good ideas.

According to MyFoxHouston.com has reported that Cemetery’s Director, Arleen Ocasio has banned saying of “God” at funerals and requires prayers be submitted in advance for government approval. What kind of an idiot is this Ocasio anyway? This smacks of what goes on in Communist China when it comes to religion. Is Ocasio a Communist working in our government? Ocasio certainly does not respect the fallen soldiers family right to have burial services that honors their faith tradition. I am appalled and angry that our fallen comrades should be treated with such disrespect. Were I in a position to, Ocasio would be immediately fired or transferred to someplace where she would feel more at home, probably communist China.

I have a CBOC 13 miles away from my house. That is where my primary care doctor is. I feel I get very good care from them. The closest Veterans Administration Medical Center (hospital) is 130 miles away. That is a 260 mile round trip. Both my father and I are 100% service connected disabled vets. When we make appointments we try to get as many as needed on the same day so we don’t spend a lot of time just running up and down the highway. Since gas prices have doubled there hasn’t been a comparable increase in travel pay and now the travel pay doesn’t cover the gas cost. I could by a newer smaller car but being on a fixed income I cant afford it. If the VA would work harder to double appointments it would save them money. Also the VA sends out notices about upcoming appointments, sometimes they will send between 3 to 5 notices for a single appointment and sometimes I get 5or 6 different envelopes on the same day, when they could put them all in the same envelope. I also have a new thing called Health Buddy that takes daily readings of things like blood pressure, pulse, respiration, blood sugar and weight. Because of this machine we have been able to take me off of 4 different medications and I like that. I live in Rural America, I live in western Kansas and there are not enough people to ever warrant a Hospital out here, but there are a ton of veterans. When I lived in Colorado I also drove 3 hours to get to the VA hospital. I must say the VA is working harder to deal with those of us who live in the backwoods. Oh and I don’t drive either.

Hello I am a Telehealth RN here at VA in Birmingham. Thank you for the previous positive commment about our Health Buddy. What a life-saver for our veterans who live near and far away. This has saved our patients countless hours of unnecessary drives to the VA not to mention they receive information concerning their diagnosis, daily questions which focuses specifically on their health care and interesting trivia. Their Primary Care Provider can simply refer these patients to our service and we will GIVE them this device and an RN who can communicate with them about their particular questions/concerns. Please ask your Provider at your VA about this..Our veterans love it ! and are more focused on getting and staying well. I am proud to be able to work in this capacity and see a very positive outcome for our nations heroes’ health situation..no matter where they live.

I am a 100% disabled Vet and our nearest community based Vet center is also 60 miles away. I live in Pagosa Springs, Co. and the Vet center is in Durango, Co. The Vet center is across a small mountain pass which can be trecherous in winter and not accesible for emergencies because of distance and terrain. In addition to the logistics is the fact that the clinic is a contract clinic and over the past four years the money making end has surpassed the care aspect for the Veteran. It has become nearly impossible to talk to anyone if you call (they will call you back within 24 hrs). The mental health therapy program has all but vanished in order to prescribe medication to address mental health issues. This situation is not at all helpful to the Veteran and seems to be getting worse.

The lastest reports that I have read advised that Civilian Rural Healthcare is fine and just as good as the rest of the country. My suggestion for Veterans in rural areas – I would like veterans to use their benefits at thier local hospital or doctor’s office instead of building VA centers in rural areas.

As for using VA benefits at local clinics and doctors, I used a local hospital and still am appealing the decision to NOT PAY. And this was an emergency. Just because the VA pays in some areas, it does not necessarily pay in others, even on appeal. An ambulance ride to the VA (heart attack) was in dispute and not paid for 3 years before they finally paid it and it was to the VA hospital.
As for my Primary Care doc. She just looked at my 2 year old records and told me if the doc then said so, I couldn’t have a problem now. Of course, she didn’t refer me to cardiology either. I agree there are some VA docs, clinics and hospitals that are great. But those are the ones that put care above the dollar or the cost. I am only 38 and do not look like I have problems. I was discharged for the very problems they refuse to treat now. I do have to say our nurse last week was awesome! She is the one that got me the information and contact that I needed (that the doc should have given). It seems the younger the vet, the less care and concern there is. However, it seems that at least more than half of the vets in our area are close to my age. I am appreciative of all veterans and would still be serving if allowed. Not only can I not get a diagnosis for my conditions and the help I need, I was discharged without a choice.
Before stating that we as veterans should utilize our local clinics, make sure that VA will pay for them. Those of us on service connected do not often have the choice of Champus or Tricare. Medically seperated means get out and no additional benefits from the military (like Tricare). Medically retired, a 20% difference related by the military NOT VA, gives us the additional help that so many of us need. However, living in a rural area does not mean Tricare is an option. I am thankful that the VA is within an hour’s drive, but wish someone would actually care and listen instead of looking at a computer screen and an old medical record. I have problems now that I had then and am getting worse. Yet, the doc seems satisfied to provide the same non-level of care I continue to receive at the VA. My only other option is 60+ miles in the other direction.

Hello,
This is in response to the travel pay, DAV issue. On 1-June-2011 the Albuquerque VAMC stopped giving travel pay on the day of your appointment. You can receive your pay trough Electronic Fund Transfer in 2-3 days or by check in 2 weeks. I’m sure that is a massive blow to a lot of people. The up side is that you don’t stand in line for 1-2 hours to get your money. I live 140 miles from the Alburquerque VA in rural New Mexico. The DAV makes stops in selected small towns. Its not uncommon for people to travel 20-30 miles to be picked up. If there is absolutely no service anywhere near a veterans home I’m sure arraingments can be made. The DAV here is great and bends over backwards to help. I would also like to say that I am an allied health professional and work at a small ruarl hospital. We have a contracted VA clinic(Ben Archer)in our town of 8,000 that is top notch. I go to the VA in Alburquerque for both specialty medical care and mental health needs and I absolutely love going there. It is some of the best care I have recieved anywhere and I have worked in Hospitals for over 20 years.

I am 100% SC DAV. I live more than 60 miles from the VAMC in Little Rock, AR. I have no complaints about the care or service I recieve. Any problems I have encountered were so minor as to be unmentionable. Thanks VA for all you do for rural vets.

I see were some believe 60 miles is a long way and I think this is just a matter of perspective. I know the veterans who live in Alaska would love to have only 60 miles. Just over 80% of our communities are off the road system and in order to receive VA Healthcare a veteran sometimes have to travel one to two days ahead of the appointment to ensure they reach the VA facility. Some have seen delays up to a week due to inclement weather. I recently had the distinct honor to have Secretary Shinseki in Alaska and had him meet some of our remote veterans. Yes it did take us a small plane, a helicopter, and a 4 wheeler to get him to the veterans; I know he now has a greater understanding of our issues in Alaska. With that said, we still have a long way to go in treating all veterans were they live. I would love to hear from those veterans who are 20% and below service connected. This is because they always pay for travel to healthcare. Here in Alaska the VA is working with rural veterans through access to healthcare through Indian Health Services. I know this is new and only time will tell how effective this is. What I would like to see in the area of rural, highly rural, and remote America is have the VA change the travel rule and pay travel for all veterans who are service connected regardless of the percentage of disability. This will help ensure that those who live outside the area were VA facilities are located would receive the same quality care as those who live close by.

The closest VA hospital to where I live is 173 miles away in Spokane, Washington. The Walla Walla VA is the closest and it is continually cutting services or contracting out. From what I have heard it plans on getting some new buildings, while continueing to do even less services with newer facilities. It was a hospital. Now it is a clinic. The area has been lacking in psych and detox type treatment facilities in the community for years and the VA continues to farm out those activities to area hospitals further burdening them with competing for available beds and all around services that they should be providing. I won’t even go into the poor treatment that I have received at the VA because I know they do seem to do well by some and terrible by others.

There is a very simple answer to the whole problem. Close all the VA hospitals and clinics. Let the Vets use their VA cards like an health insurance cards and go to their local doctors and hospitals. Nowadays, there is nothing special about VA care that is not offered by the private sector. Since the goverment cannot operate anything as efficient as the private sector, I am guessing it would save the tax payer about 70%. The last I checked, the government (VA included) spends about 70 cents on the dollar in bureaucracy and 20 cents on the vets. The private sector reverses the numbers. Don’t think it will work? How does Medicate do it?

I live in Missouri and 65 miles from the Harry S Truman VA Hospital, I have had very good service at that hospital, and travel pay is paid as soon as you get done with your DR. and you get in line at the cashier, no complaint their,
we have had a raise in travel pay in the last year,but with the cost of Gas about pays it’s own way, they are building a intensive care wing and a Heart wing onto the Hospital, hopefully I will never need it, but it will be their just encase,,,,,,,,R Graham

Drove 30 miles to have fasting blood drawn at CBOC Non english speaking person came to waiting area tried to say John Grey, not actual name, but you get the picture. The only other guy in the waiting area and I figured out it must be him so he went in for his blood draw. Now I’m the only vet in the place,15 minutes goes by, John is finished and leaves. 5 minutes later another vet checks in for blood work. 5 minutes later same lady comes out calls not my name other vet gets up has blood work done. I am alone again, now I go to front reception to see if I’m checked in. Girl at desk goes to lab and comes back to say I’m next. Well I was next half an hour ago. I guess I should be grateful for the free medical I get but I just can’t understand the attitude of some of the staff at these facilities.

There is a pretty cool program operating out of a VA in Asheville, NC that brought a flu shot to my town, and set up another clinic providing a pneumonia shot; now I’m hearing they may be setting up clinics in existing sites by sharing agreements with other federal, state and local health care entities to provide limited appointments for people who otherwise might fall through the cracks…especially in mental health. Talked with a really nice gentleman from the Rural Health program at Grandfather Mountain at the highland Games this past Friday, and the team themselves are excited . I just hope the Feds don’t get in the way and block all of their good ideas.

Fee Basis, in my experience, is difficult and the VA wastes so much time in paying bills. I have a $700 bill that is from 2010, Feb., and am being threatened with court by the radiology’s attorney. I have been to Fee Basis (Jesse Brown Chicago) each time I have an appointment with a specialist, and they promise, promise. promise to get it paid every time. I have been to their office seven times, and have talked with them on the phone more tha that. The hospital has also not been paid, and from what I undestand, much of the reason is because the bill was submitted originally on a black coded form rather than a red one.

This is not the first time I have had problems with Fee Basis. I went to the emergency room in 2003 with kidney stones. The bill was $7,500. It was all demied. I appealed it and when I talked to Fee Basis they said that it would be impoossible to pay such a bill. When I told them that Congress had passed a law in 2002 that made it possible for veterans to go to a hospital other than the VA if their pain was bad enough to make the veteran feel it endangered his life, they laughed and said there was no way that there was such a law. I sent them the law. Inover a year’s time, no one at the VA there had ever seen the law. My case was reviewed by the hospital administrator and the bill was all paid. Even after that, a doctor who had seen me while I was in the hospital tried to collect for his treatment time for four years, it going to a collection agency in Piledelphia, who sent me bills for all those years, every six months. After many calls to Fee Basis, it was finally paid. Since 2003 I have been in a public hospital three times, and virtually all bills were paid.

I live 45 miles from the Crown Point clinic, and must wait for travel pay; and over 90m miles from Jesse Brown in Chicago. When I go to the specialy clinics in Chicago I usually drive myself. There is a shuttle from Crown Point, but it is not convenient, and means a full day if you see a specialist.

Travel pay for Crown Point has alsway been paid by a check by mail, yuou usually have to wait about 60-90 days; travel pay was paid be cashable vocher at Jesse Brown until recently. They changed it to the mail system, saying that two many vets living in Chicago were lising addresses in Indiana, so they could collect big travel pay checks. The Chicago vets messed up our travel pay system, and now, if we are short money, we have to decide to ride the shuttle, or really pich pennies until the check comes in the mail.

I have heard, that if you ask for a meal ticket if you have to spend a day, you can get it, although I never have actually gotten one, other that when I had a colonoscopy, they gave us a meal after I had the test. That was back in the 80’s.

Folks.
Does anyone know what happened to the plan of allowing veterans use the community facilities? Whenever I need medical assistance I’m in the same boat as many of you are. The clinic i about 54 miles away, but as told by my primary doctor’s office the do not take in emergencies. So then I have to drive 74 miles to the nearest VA Med Center, then You have to wait for hours to see a doctor. Isn’t it interesting that you can’t go on sick call at a VA clinic? Yes our government is very much lacking. Many of us can recall the old promise, “Let it all hang out, if you get hurt UNCLE will take care of you.” Well the administration who promoted that is gone and the one who replaced them did not inherit that promise. Hang in there VETS maybe someone will get it straight.

I am a 42 year old female vet in Idaho. The closest CBOC is about 70 miles away, that is where I see my general practitioner. I do not get travel pay for about 6 weeks for these appointments. It is an annoyances and I am always thankful that I am able to wait to get paid, if I get paid. When I call to check on travel pay, the folks I have to deal with are incredibly rude and dismissive. I have discussed this with the patient advocate but he seems unconcerned.
To see a specialist, I must drive to Boise, 150 miles away, that is a whole day of work lost.
If I see a doctor locally, TriCare pays about $70 and I pay about $25. I would rather see a local doctor as long as I could get my meds through the VA. The $70 for TriCare is cheaper than the $130 they pay me to drive to Boise.
Lab work has become an issue as well since my doctor has not been able to get a fasting cholesterol on me in years. It is too far on an empty stomach, I would become a hazard on the highway.
I know women’s health has become a big issue over the past 10 years, I’ve watched it happen. The VA seems more than happy to contract mammograms with the local hospital, why not more public/ private partnerships?

We are also in the same situation as many of you are. The VAMC closest to us is 85 miles away. We work nights and when my husband has an appt. it is always scheduled for early in the morning, meaning we are on the road with very little if any sleep which is not safe. We do have a local VA clinic but it is used mainly for blood draws which helps us because my husband is on coumadin. The local clinic is also where my husband has his yearly check ups, if you want to call them that (his primary doc sits behind his computer and asks a few questions and it’s done). Seems like the yearly check up would involve more than this seeing as my husband has atrial fib and in February was diagnosed with cancer. We have also have had to make trips to the emergency room of our local hospital for his A fib and have had payment of charges denied. Three weeks ago my husband was not feeling well and was having trouble breathing and some pain in his chest at work and had to leave work and drive 85 miles to the VAMC emergency room to get checked. I couldn’t leave work to go with him because there was no one there to cover my shift. This was absolutely not safe for him to do but we can’t afford another bill to pay at our local emergency room because the VA might deny the charges. Not just my husband but all VETS have served our country and they shouldn’t have to go through what they go trough to get the care they need.

I also live in a rural area with it being 40 miles to the CBOC and 79 miles to the VAMC. Of course that VAMC isn’t equipped to handle all tests or procedures, which means, in those situations, a 90 mile trip into New York City is the only alternative.

I am a 100% disabled vet, with some serious health issues. This past week I had to drive to the VAMC for 3 different appointment, somehow none of the doctors work on the same day (they split their time and travel to either CBOCs or another VAMC). So three trips in 3 days, between travel time, waiting time and examinations a total of 22 hours spent going back and forth. One of the doctors recommended physical therapy. It is ridiculous to have to drive three times a week, some 540 miles to receive treatment. Also the benefit of the treatment would be diminished, if not totally negated by the time I returned home after driving my car an hour and 45 minutes.

The VA already has the answer, but they refuse to use it. It is called a Fee Basis referral. The regulation is clear that when the VA can’t provide the service in the veteran’s community, a fee basis may be authorized. Just try to get one authorized. You have a better chance of winning the mega million lottery.

What makes even less sense, is that fee basis is reimbursed at the rate of medicare reimbursement (as of this year). Since I am eligible for Medicare, all it would be doing is taking the money out of the government’s one pocket and put it in another. Try explaining this to the folks at VA.

I am now in the process of obtaining private physicians and will use the VA for medications and testing. For those that have to rely only on the VA, you are caught between the proverbial rock and a hard place.

Yet, we will continue to get these wonderful articles that tell us how much the VA is doing and how much they care. I wonder, if after writing, these articles and reading the comments they still believe they live in the same world?

I LIVE 105 MILES (ONE WAY) FROM THE V. A. HOSP. THE V. A. REIMBURSESS ME FOR MILEAGE. MY NURSE PRAT. SAID I SHOULD NOT DRIVE BY MY SELF BECAUSE I AM HARD OF HEARING AN APPROCHING CAR. IF I GET SOMEONE TO COME WITH ME, WILL THE V. A. PAY HE OR SHE??? THANKS JESSE BARNETT 309 DRIFTWOOD DRIVE, MERIDIAN, MS. 39395

Our Community is Big Spring Texas. We went through the CARRS Commission Years ago and were told because of our LOCATION to our Rural VETERANS We would keep our facility. Well, now we are LOOSING SERVICES… our hospital has gone to URGENT CARE open M-F 8-5 no weekends no holidays. Folks here are told to go to ALBUQUERQUE New Mexico. 406 miles away. WE HAVE A 6 story BUILDING. That used to be a fully functioning Hospital… OFTEN Veterans are told to use the LOCAL hospital — So far, I HAVE NOT seen payment from the VA to cover these costs. WE HAVE COMPLAINED TO THE HOSPITAL ADMIN. — we get the same line “WE ARE PROVIDING THE BEST HEALTHCARE POSSIBLE” Medicaid patients get better treatment. It is not fair to our Soldiers or our Medical Professionals. WE ARE Visn 18Bigspeing@msn.comhttp://www.newswest9.com/story/15023561/veterans-families-protest-at-big-spring-va-hospital

Our Community is Big Spring Texas. We went through the CARRS Commission Years ago and were told because of our LOCATION to our Rural VETERANS We would keep our facility. Well, now we are LOOSING SERVICES… our hospital has gone to URGENT CARE open M-F 8-5 no weekends no holidays. Folks here are told to go to ALBUQUERQUE New Mexico. 406 miles away. WE HAVE A 6 story BUILDING. That used to be a fully functioning Hospital… OFTEN Veterans are told to use the LOCAL hospital — So far, I HAVE NOT seen payment from the VA to cover these costs. WE HAVE COMPLAINED TO THE HOSPITAL ADMIN. — we get the same line “WE ARE PROVIDING THE BEST HEALTHCARE POSSIBLE” Medicaid patients get better treatment. It is not fair to our Soldiers or our Medical Professionals. WE ARE Visn 18Bigspring@msn.comhttp://www.newswest9.com/story/15023561/veterans-families-protest-at-big-spring-va-hospital

I have been filing medical PEB boards for myself and others since my medical discharge in 1992. It was 3 years before I was accepted into and recieved my first payent of $98, after the DOD medical avaluation of 60 – 100% was cut to 10% by the VA. Over the last 19 years I am 100% unemployable at the age of 40. I lost every job, and my education benefits have been cancelled twice, social security applications systematically denied, CHAMPVA systematically denied, and I live 78 miles NW of the closest VAMC in a rural area. My credit is ruined from the last 5 years of emergency services being denied by fee services, the private sector reports it on your credit w/in 90 days, Fee services is given 2 years to pay. I am married with 3 kids living on a fixed income with bad credit. We have to pay more for utilities, car insurance, rent, (Can’t buy), and our only vehicle needs to be replaced. If our medical bills are filed to the VA in a manner that the VA is an insurance company, why didn’t the VA see any funds when the auto industry, finance, and insurance companies received bailouts?

The VA socialized healthcare is rumored to be what is planned for all Americans, yet everyone that has a veteran friend or family member knows how poorly the system functions now matter the per capita. This year was the first year since I was discharged that I actually started receiving travel pay of $51, which even if the fuel was $2 a gallon would not cover fuel, daycare, and eating a snack while spending the day at the VAMC.

The Outpatient clinic I transfered my PC to did a great job in 2009 when I started, now they are concentrating on 1 higher clientel in order to get more services from the VA Outpatient services.

A short history for me since 2005 in a wheel chair: Removal of Cysts and abcesses, sliding down a icy sidewalk into a tree, sliding sideways down a sidewalk covered in grass clippings & dumped on to a gravel drive, 2 heart attacks, 2 pitbulls that killed our dog and then went for our kids (I tackled them) then being dragged around the yard for 20 min before police & EMT arrived, and 3 seperate drunk drivers hitting me.

So, quit a bit for a full time college student that lost the education benefits after taking the LSAT, and being accepted to law school. Then the infinite wisdom of Voc Rehab decided I was medically unfit to complete my education.

The VA is one big system micromanged into districts, which are micromanaged by regions, which are micromanaged by facilities, which are micromanged by departments, which are micromanged by administrative guidelines.

I don’t believe even my 4 year old will ever see a compatable VA service for those who honorably serve and fight to get what we “are eligible for” through an application process.

I am in complete agreement with the other Victims of the VA’s fee-based denial.
My husband has Parkinson’s Disease and cancer of an unknown primary. We live 2 hourse from MD Anderson Cancer Center (Platinum Standard Care) or 2 1/2 hours from the VAMC in Temple, Tx. I have begged for over a year now for him to be able to get a second opinion as to his cancer at MD Anderson (who, btw, does most of the FEE BASED care for Vets who go to the Houston VAMC as primary care). I have been told flatly that it’s not possible.
due to the Chemotherapy and radiation excabricating my husband’s SERVICE CONNECTED Parkinson’s Disease (Agent Orange presumptive 100% SC Compensation), he is unable to even dress himself now. It takes us 6-8 months to see his neurologist (VA Austin, Tx outpatient clinic) and he has become allergic to 2 of his Parkinson’s Medications..including a “rare” adverse interaction between them and his Chemo that cause him total dementia for 4 days.
I have quit my job to care for him. His primary care Doctor (VA College Station, Tx) REFUSES to even FILE the form for Aid and Attendance or SMC.
I have had to FIGHT tooth and claw for every bit of “care” my husband has recieved, and have been begging for 12+ months for him to see a PT/OT to determine what we can do to facilitate him having the ability to perform ANY ADLs independantly.
I contacted the “Caregiver Support” caseworker at the VA in April…we’re still on a waiting list for any assistance.
I’m frustrated, tired, and on call 24/7 for my husband while his doctors get to take the weekends off. Call me crazy, but I’m sick of this.

With the recent debt deal and the impending spending cuts which will be occuring, I suspect that rural VA health care will be cut significantly. It is bad enough to wait two months to see a VA health care provider which I have experienced in the past. About the only thing that the VA can do to fill the gap is to hire secondary care specialists like Physician Assistants and Nurse practitioners, but given that one of the growth areas in jobs in the USA is in healthcare, these PA’s and Nurse Practitioners will opt for Private Healthcare jobs as Federal Pay/Benefits are cut, and the high demand for these positions in the Private sector.

Personally, I do hope that the bipartisan committee does not cut VA Healthcare money for disabled vets like myself (I am 80 percent Service Connected disabled), but again, I do not hold up too much hope. In terms of the waits, VA healthcare is bad, but I think it is going to get worse after the budget cutters get their hands on it.

This is no reward for any Veteran who served and nearly died for the United States, and especially for service connected disabled Vets like myself. But leave it to the Tea Party to really screw the Veteran/Disabled Veteran after they bravely served their country.